How John McCain became the pivotal vote that sent the GOP's healthcare efforts into disarray

Sen. John McCain stunned much of the US and his party leaders on
Friday, when shortly before 2 a.m. ET he voted against against a
"skinny" plan to repeal parts of the Affordable Care Act.

McCain joined two other Republican senators, Susan Collins of
Maine and Lisa Murkowski of Alaska, who
voted against the bill and quashed Majority Leader Mitch
McConnell's plan to upend the US healthcare system after 20 hours
of debate.

Going into the debate period

Before the American Health Care Act passed the House, McCain had
doubts. In March, he
told reporters that he was concerned about how the bill would
affect Arizona. The House bill cut hundreds of billions in
Medicaid funding. Arizona, which had opted to expand Medicaid
coverage under the ACA,
would stand to lose a significant amount of funding.

Then came his surgery. On July 14, McCain had brain surgery above
his left eye to remove a blood clot. The recovery period
threw Senate Republicans' healthcare plans into jeopardy.
McCain was expected to vote for the Better Care Reconciliation
Act, even though he had concerns about that bill as well.

On Tuesday, McCain returned to Washington shortly after doctors
diagnosed him with
glioblastoma, an aggressive form of brain cancer. He voted in
favor of a motion to proceed to debate the healthcare bill, a
move for which Democrats criticized him.

Following the vote, McCain delivered a speech in which he touched
on his lingering concerns about the bill, working together with
Democrats, and his plans to return to Arizona for cancer
treatment.

"What have we to lose by trying to work together to find those
solutions?"
McCain said. "We're not getting much done apart. I don't
think any of us feels very proud of our incapacity. Merely
preventing your political opponents from doing what they want
isn't the most inspiring work. There's greater satisfaction in
respecting our differences, but not letting them prevent
agreements that don't require abandonment of core principles,
agreements made in good faith that help improve lives and protect
the American people."

A shift to get 'skinny'

After two failed votes, the conversation Thursday started
shifting more seriously to a plan for a
"skinny repeal" bill, which would get rid of some of the main
parts of the ACA, including the individual and employer insurance
mandates. The idea was to pass the bill, then send it to the
House. Then the two chambers could conference on the bill and
create a healthcare plan on which both could agree.

In short, the Senate would pass a bill many senators vehemently
didn't want to become law, then hope Republicans came out of the
conference with a better plan.

That afternoon, McCain was one of four Republicans who spoke out
against the "skinny repeal" plan. At
a press conference, McCain, along with Sens. Lindsey Graham,
Ron Johnson, and Bill Cassidy, demanded that the House give
assurances that the bill wouldn't become law if it passed in the
Senate.

The text of the "skinny" bill
came out about 10 p.m. ET on Thursday. When asked an hour
later whether he'd made up his mind on the bill, McCain told
reporters that he had. As for which way he would vote, he
wouldn't say.

"Watch the show," he told reporters as he walked into the chamber
for the vote.

In a surreal scene on the Senate floor, McConnell and Vice
President Mike Pence were seen before the vote speaking with
McCain. The Senate left open a previous vote for more than 40
minutes as it appeared Republican leaders attempted to persuade
McCain to change his vote. McCain had curious exchanges with
Democratic senators, including a conversation with Minority
Leader Chuck Schumer, who gave
McCain an apparent fistpump.

McCain also took a phone call from President Donald Trump after
McConnell's and Pence's attempts to persuade him had failed,
according to
Politico. Trump's sell also failed.

The vote began, and McCain came to the Senate floor and put his
right thumb down before walking off.

In a statement released Friday,
McCain explained that he voted no because the speaker's
statement didn't go far enough, and the "skinny" bill didn't
offer up a replacement plan. As he did earlier in the week,
McCain urged both parties to work together.

"We should not make the mistakes of the past that has led to
Obamacare's collapse, including in my home state of Arizona where
premiums are skyrocketing and health care providers are fleeing
the marketplace," he said. "We must now return to the correct way
of legislating and send the bill back to committee, hold
hearings, receive input from both sides of aisle, heed the
recommendations of nation's governors, and produce a bill that
finally delivers affordable health care for the American people.
We must do the hard work our citizens expect of us and deserve."

McCain came out with a second statement on Friday emphasizing his
hopes for a bipartisan healthcare plan.

"I have great faith in the ability of the Senator from Tennessee,
Lamar Alexander, the Senator from Washington, Patty Murray, and
others to work together in a bipartisan fashion to craft a bill
that increases competition, lowers costs, and improves care for
the American people," he said. "I encourage my colleagues on both
sides of the aisle to trust each other, stop the political
gamesmanship, and put the health care needs of the American
people first. We can do this."